Resumo

DARBAS BARBE, Raúl et al. Vascular access puncture using fistula catheter: effect on the patient's pain and adequacy of hemodialysis. Enferm Nefrol [online]. 2015, vol.18, n.3, pp.163-167. ISSN 2255-3517.  https://dx.doi.org/10.4321/S2254-28842015000300003.

Introduction: The use of new needle designs for VA puncture may improve the quality of life of patients (pts) and the parameters of HD efficacy. Objectives:To evaluate whether there are differences in the intensity of the pain perceived by the pts and HD adequacy (Kt Index) after brachial arteriovenous fistula (AVF) puncture through catheter-fistula (CF) or standard needling (SN). Patients and methods: We performed a prospective, controlled, nonrandomized study during 2 months (24 HD sessions) to compare needling by CF (cases) versus SN (controls) in prevalent HD pts dialyzed by brachial AVF. The same patient was the case and the control when the CF (12 sessions) and the conventional 15G needle (12 sessions) were used, respectively. The CF is a biocompatible puncture cannula composed by an internal metal needle intended to AVF puncture and an external fluroplastic catheter (15G) that remains inside the arterialized vein. The pain related either with needling or with needle withdrawal was quantified using a validated visual analogue scale (VAS) and the ShortForm McGill Pain Questionnaire (SF-MPQ). Results: We analyzed 14 prevalent HD pts (mean age 68.4 +/- 10.43 years; 71% male; 28.6 % diabetic nephropathy; mean time on HD 36.57 +/- 18.28 months) dialyzed by brachiocephalic (50%), brachiobasilic (21%) or brachioperforating (29%) fistula. During both needling and needle withdrawal, the VAS was significant lower for CF (2.07 +/- 0.73 and 0,76 +/- 0,39) compared to SN (2.88 +/- 0.99 and 1.85 +/- 0.95) (for both comparisons, p < 0,001). No significant difference was found when comparing the SFMPQ score during HD session between CF and SN (0.03 +/- 0.07 versus 0.11 +/- 0.26, p = 0.13). The venous pressure (mmHg) recorded during the first and last hour of HD session was significant lower for CF (171.2 +/- 15.5 and 174.4 +/- 16.7) compared to SN (194.9 +/- 15.1 and 198.0 +/- 20.1) (for both comparisons, p < 0,001). The Kt index obtained was significantly higher for CF (51,1 +/- 3,6 L) compared to SN (48.4 +/- 3,1 L) (p < 0.001). No AVF leakage episodes were recorded with CF and only one by SN (p = NS). Conclusions: In relation to the standard needle, the use of fistula catheter decreases perceived pain in the puncture and removal of the needle (visual analog scale), and improving the adequacy of hemodialysis (Kt index).

Palavras-chave : pain; vascular acces; Kt; catheter-fistula; EVA; MPQ.

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